Micropapillary or solid pattern predicts recurrence free survival benefit from adjuvant chemotherapy in patients with stage IB lung adenocarcinoma

• DOI: 10.21037/jtd.2018.08.64
• Publication Date: 2018-09-29T03:16:12Z
• Authors: Minjie Ma; Yunlang She; Yijiu Ren; Chenyang Dai; Lei Zhang; Huikang Xie; Chunyan Wu; Minglei Yang; Dong Xie; Chang Chen
• Keywords: 0301 basic medicine; 03 medical and health sciences; 3. Good health

Our study aimed to evaluate the prognostic significance and adjuvant chemotherapy (ACT) benefits of a micropapillary/solid (MS) pattern in patients with stage IB lung adenocarcinoma.Patients with pathologically-confirmed stage IB adenocarcinoma who underwent surgical resection between January 2009 and December 2011 were included. The tumors were reclassified into three categories: MS patterns absent (MS-); non-predominant MS patterns (MS+); predominant MS (MS++). The correlations of prognosis and ACT with recurrence-free survival (RFS) were evaluated.Overall, 497 (MS-, n=269; MS+, n=177; MS++, n=51) patients were enrolled in the study. In univariate analysis, the MS+ [hazard ratio (HR), 1.437; 95% confidence interval (CI), 1.030-2.006; P=0.033] and MS++ (HR, 2.818; 95% CI, 1.792-4.432; P<0.001) groups had significantly poor prognosis compared with MS- group. Multivariate analysis revealed that age ≥65 (HR, 1.504; 95% CI, 1.077-2.099; P=0.017), serum level of carcinoembryonic antigen (CEA) ≥10 ng/mL (HR, 1.658; 95% CI, 1.048-2.623; P=0.031) and MS++ (HR, 2.529; 95% CI, 1.550-4.126; P<0.001) were significant prognostic factors. Furthermore, subgroup analysis showed that MS++ patients but not MS- and MS+ derived RFS (recurrence-free survival) benefit from ACT (HR, 0.357; 95% CI, 0.152-0.836; P=0.018).MS pattern successfully differentiated the prognosis difference among stage IB lung adenocarcinomas and identified patients who benefitted from ACT.